Abstract / Project Summary Approximately 360 million people worldwide have disabling hearing loss and the vast majority live in Low and Middle Income Countries (LMIC) were services are scarce. Hearing loss is the most common birth defect and many cases of childhood hearing loss in LMIC are related to untreated ear infections. Unfortunately, many cases of pediatric hearing loss are unrecognized. Many of these children will suffer from poor language development, educational outcomes, and employment opportunities if the hearing loss is untreated. School hearing screening in LIMC is challenging due to high background noise in these environments and the lack of trained personnel. Preliminary research in rural Nicaragua suggests that 27% of schoolchildren fail initial hearing screening exams, but poor quality screening exams from high ambient noise levels lead to a presumed high rate of unnecessary referrals. Less than 10% of these children ever receive further evaluation or treatment. Mobile health techniques that provide early and accurate recognition of childhood hearing loss, combined with a reminder system for appointments, could improve the outcomes from hearing screening efforts. This project combines a team experienced in hearing testing in both rural Nicaragua and Tanzania (Saunders, Buckey) with an innovative noise attenuating-wireless headset with direct mobile communication (via cell phone or internet). Creare, LLC has developed a hearing threshold screening device that performs automated audiometry, is controlled through a mobile platform, and provides superior background noise attenuation using innovative, integrated, high-quality, noise-attenuating ear cups. This technology can also communicate directly with a mobile health network to facilitate initial management and follow up appointments. This project will demonstrate that minimally-trained personnel can use mobile-health-technology-based hearing screening to perform high-quality audiometry on Nicaraguan school children in their schools. The efficacy of this mobile-health-technology-based system will then be investigated in a large-scale study of schoolchildren in rural communities throughout Jinotega, Nicaragua. Children who fail automated hearing exams with this system will receive further evaluations (otoscopy and tympanograms) and management recommendations if appropriate. This information and mobile contact numbers will be uploaded to a Mobile Hearing Health Management System (mHHMS) based on the widely available web-based database management system REDCap, which will be used to make necessary medical and audiology appointments in real time, send reminders regarding appointments, and track identified children through this process. Finally, this mobile health system will be used to determine the prevalence and socio-geographical distribution of hearing loss in Nicaraguan school children. We hypothesize that we will be able to improve outcomes in hearing screening by performing high-quality audiometry in the field, improving compliance with follow-up appointments, and reducing unnecessary referrals.